I wonder how it is all these years I could have my eyes open and know what is going on around me, yet be considered "vegetative." I got to thinking about the levels of consciousness (LOC). (For ease I will use Wikipedia http://en.wikipedia.org/wiki/Altered_level_of_consciousness)
DefinitionScales and terms to classify the levels of consciousness differ, but in general, reduction in response to stimuli indicates an altered level of consciousness:
|Conscious||Normal||Assessment of LOC involves checking orientation: people who are able promptly and spontaneously to state their name, location, and the date or time are said to be oriented to self, place, and time, or "oriented X3". A normal sleep stage from which a person is easily awakened is also considered a normal level of consciousness. "Clouding of consciousness" is a term for a mild alteration of consciousness with alterations in attention and wakefulness.|
|Confused||Disoriented; impaired thinking and responses||People who do not respond quickly with information about their name, location, and the time are considered "obtuse" or "confused". A confused person may be bewildered, disoriented, and have difficulty following instructions. The person may have slow thinking and possible memory time loss. This could be caused by sleep deprivation, malnutrition, allergies, environmental pollution, drugs (prescription and nonprescription), and infection.|
|Delirious||Disoriented; restlessness, hallucinations, sometimes delusions||Some scales have "delirious" below this level, in which a person may be restless or agitated and exhibit a marked deficit in attention.|
|Somnolent||Sleepy||A somnolent person shows excessive drowsiness and responds to stimuli only with incoherent mumbles or disorganized movements.|
|Obtunded||Decreased alertness; slowed psychomotor responses||In obtundation, a person has a decreased interest in their surroundings, slowed responses, and sleepiness.|
|Stuporous||Sleep-like state (not unconscious); little/no spontaneous activity||People with an even lower level of consciousness, stupor, only respond by grimacing or drawing away from painful stimuli.|
|Comatose||Cannot be aroused; no response to stimuli||Comatose people do not even make this response to stimuli, have no corneal or gag reflex, and they may have no pupillary response to light.|
The beginning of consciousness.
Looking at this, I was awake, but "confused" in the beginning. I wouldn't have used that term, but rather have used "impaired thinking". I wonder now...the definition of this state says "People who do not respond quickly...." I did not respond quickly. I still don't. If you have heard my voice it is rather slow. At the time of hospitalization, it was even slower, or not even there at all.
Was it really a consciousness problem, or a communication problem?
|It clearly becomes discrimination of my speech. Ask me to write it out and I can. Sure it might take me awhile because I only type with one hand. If I have to verbally say it, forget it. You may or may not even understand me. Again, at issue is speed. In order to be conscious I must be fast and and my speech understood. If that is the criteria, I fail.|
Writing became my main method of communication.
In the hospital, I was having a problem getting people to read what I wrote. This was a long process for me. I needed another person because my arms didn't work. This meant waiting (sometimes days) for my mother to visit so I could have someone write it out. Staff weren't reading the messages I had her write, so I came up with a different idea...
(This is El Camino Hospital, around St Patrick's Day, as you can see by the shamrocks on the door.) Look at my shirt. It's covered part-way, but reads "IF I GAVE A SHIT, YOU'D BE THE FIRST PERSON I'D GIVE IT TO." Staff read that! I got more.
I guess consciousness was in a sarcastic t-shirt quote...with a curse word.
Conscious but Different.
I am different. The word "vegetative" has been used to describe what I am, although this is a misuse of the term. I am not vegetative. I'm just very slow. The slowness appears when I talk, not when you read. If I try to speak faster, you can't understand me.
|If the data doesn't fit, you don't throw out the data. You throw out the idea. So I don't fit. You don't put me in a category just to get rid of me. Throw out your idea and start over; no assumptions.|